#00064073

A 63-year-old woman was admitted to our Hospital due to COVID-19 and enterocutaneous fistula. Her medical history included spastic paraplegia, palliative colostomy two years ago due to locally advanced orthosigmoid carcinoma with liver metastases, subsequent chemotherapy, Hartmann colectomy and partial liver resection due to disease remission. Due to a postoperative leakage, an investigative laparotomy and an ileostomy of the bracket had been performed as well as a mesh placement. In our Hospital, CT revealed both fistula and local recurrence of the disease in the pelvis. The patient was treated conservatively, with parenteral nutrition and intravenous antibiotics. During her hospitalization, a peripheral blood smear was performed in the context of an investigation of emerging thrombocytopenia, where we observed phagocytosed bacteria by neutrophils (Panels A-F & H), by eosinophils (Panel K), but also scattered (Panels G-J) (May-Grünwald-Giemsa, MGG, x100). It was remarkable that at the same day the patient was afebrile. Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae was isolated from blood cultures taken at the same day. The patient died one month later due to metabolic acidosis and septic shock. The identification of phagocytosed or extracellular bacteria in MGG stain is extremely rare and seems to reflect a particularly high burden of bacteremia.